title: Mortality trends in patients with and without diabetes in Ontario, Canada and the UK from 1996 to 2009: a population-based study.
abstract: OBJECTIVE
  The aim of this study was to determine the contemporary rate ratio of mortality and changes over time in individuals with vs without diabetes.
  
  
  METHODS
  Annual age- and sex-adjusted mortality rates were compared for adults (>20 years) with and without diabetes in Ontario, Canada, and the UK from January 1996 to December 2009 using The Health Improvement Network (THIN) and Ontario databases. The total number of individuals evaluated increased from 8,757,772 in 1996 to 12,696,305 in 2009.
  
  
  RESULTS
  The excess risk of mortality for individuals with diabetes in both cohorts was significantly lower during later vs earlier years of the follow-up period (1996-2009). In Ontario the diabetes mortality rate ratio decreased from 1.90 (95% CI 1.86, 1.94) in 1996 to 1.51 (1.48, 1.54) in 2009, and in THIN from 2.14 (1.97, 2.32) to 1.65 (1.57, 1.72), respectively. In Ontario and THIN, the mortality rate ratios among diabetic patients in 2009 were 1.67 (1.61, 1.72) and 1.81 (1.68, 1.94) for those aged 65-74 years and 1.11 (1.10, 1.13) and 1.19 (1.14, 1.24) for those aged over 74 years, respectively. Corresponding rate ratios in Ontario and THIN were 2.45 (2.36, 2.54) and 2.64 (2.39, 2.89) for individuals aged 45-64 years, and 4.89 (4.35, 5.45) and 5.18 (3.73, 6.69) for those aged 20-44 years.
  
  
  CONCLUSIONS
  The excess risk of mortality in individuals with vs without diabetes has decreased over time in both Canada and the UK. This may be in part due to earlier detection and higher prevalence of early diabetes, as well as to improvements in diabetes care.
authors.affiliation: Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, lind.marcus@telia.com.
authors.forename: M
authors.initials: M
authors.lastname: Lind
authors.forename: L A
authors.initials: LA
authors.lastname: Garcia-Rodriguez
authors.forename: G L
authors.initials: GL
authors.lastname: Booth
authors.forename: L
authors.initials: L
authors.lastname: Cea-Soriano
authors.forename: B R
authors.initials: BR
authors.lastname: Shah
authors.forename: G
authors.initials: G
authors.lastname: Ekeroth
authors.forename: L L
authors.initials: LL
authors.lastname: Lipscombe
mesh_terms: D000328:Adult; D017677:Age Distribution; D017668:Age of Onset; D000368:Aged; D002170:Canada / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000401:mortality*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011159:Population Surveillance; D015995:Prevalence; D017678:Sex Distribution; D015996:Survival Rate / Q000639:trends; D006113:United Kingdom / Q000453:epidemiology